Novel treatment (new drug/intervention; established drug/procedure in new situation)

CASE REPORT

Alternatives for restoration of a hemisected

mandibular molar
Y G Naveen, Jayanti R Patel, Pooja Parikh, Khyati Shah

Department of Prosthodontics, SUMMARY

K.M Shah Dental College and Hemisection is a common conservative treatment option
Hospital, Sumandeep
Vidyapeeth, Vadodara, Gujarat, for periodontally or endodontically compromised teeth. It
India is most likely to be performed on mandibular molars
with class II or III furcation involvement. Their restoration
Correspondence to is more critical than implant surgery to ensure the ability
Professor Jayanti R Patel,
to masticate along with the ability to maintain good oral
[email protected]
hygiene. There are various alternatives to restore such
Accepted 29 June 2014 types of teeth: the remaining root restored as an
individual tooth, restoring individual roots with either a
molar or premolar morphology using the adjacent tooth
as an abutment in a full coverage fixed partial denture,
restoring individual roots with either molar or premolar
morphology using an inlay type of restoration on the Figure 2 Clinical examination of a hemisected molar
adjacent abutment tooth. This article reports two cases, (case 1).
one treated with molar morphology and an inlay type of
restoration and the other with a premolar morphology
and a full coverage fixed partial denture. root was planned (figure 2). The opposing first
molar and left mandibular molar were absent.
Case 2: A 39-year-old male patient reported with
a 3-week history of pain on the lower left side of
BACKGROUND
his mouth. The patient reported a history of root
Hemisection leads to an increased risk of caries in
canal treatment in the mandibular first molar since
the area of resection due to the increased difficulty
6 months. Radiographic examination showed a
in maintaining hygiene of the area and increased
broken instrument in the mesial root of the man-
stress on abutment teeth if the span is too wide
dibular first molar (figure 3), and therefore a hemi-
because of the loss of 50% of the root structure
section of the mesial root was planned (figure 4).
resulting in mobility or fracture due to structure
The examination revealed that all other teeth were
loss.1 2
intact.

CASE PRESENTATION
Case 1: A 35-year-old female patient reported to INVESTIGATIONS
our hospital with a symptom of pain and decay on Case 1: Intraoral periapical radiograph of 46 con-
the right side of her mouth. On radiographic exam- firmed root caries in the distal root (figure 1).
ination, the mandibular first molar showed the Posthemisection, an intraoral periapical radiograph
presence of carious involvement in the distal root in relation to 45, 46 and 47 showed the presence
(figure 1). The adjacent premolar and molar were of the mesial root and crown structure of the first
intact and healthy, so a hemisection of the distal

To cite: Naveen YG,

Patel JR, Parikh P, et al. BMJ
Case Rep Published online:
[please include Day Month
Year] doi:10.1136/bcr-2013- Figure 1 Preoperative intraoral periapical radiographs
010275 (iopa) (case 1). Figure 3 Preoperative iopa (case 2).

Naveen YG, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-010275 1

 Novel treatment (new drug/intervention; established drug/procedure in new situation)

Figure 6 Postoperative iopa (case 2).

embrasures and least gingival involvement, which would enable

the patient to maintain oral hygiene (figure 8).
Case 2: Tooth preparation was performed using principles of
tooth preparation and full metal fixed restoration (figure 9) with
Figure 4 Clinical examination of a hemisected molar (case 2). pre molar anatomy. Point design was selected as hygienic one to
ensure easy clinic and maintenance of tissue (figure 10).

mandibular molar. The second premolar and molar were sound

with good bone support and an appropriate crown-root ratio OUTCOME AND FOLLOW-UP
(figure 5). These treatments restored the form and function of the hemi-
Case 2: Intraoral periapical radiograph of 36 confirmed the sected tooth and improved the patient’s ability to chew on the
presence of a broken instrument in the mesial root (figure 3). concerned side. It allowed the patient to maintain good oral
Posthemisection, an intraoral periapical radiograph in relation to hygiene and reduce the risk of caries associated with
35 and 36 showed the mesial root of the left first mandibular hemisection.
molar. The second premolar and distal part of the molar were
sound with good bone support and an appropriate crown–root
ratio (figure 6). DISCUSSION
Hemisection has been used successfully to retain teeth with fur-
cation involvement. However, there are a few disadvantages
TREATMENT associated with it. It can cause pain and anxiety; more suscepti-
Case 1: An all metal fixed partial denture with molar morph- bility to caries especially at the site of hemisection, an improp-
ology for the hemisected 46 and an inlay type of restoration on erly shaped occlusal contact area, may convert acceptable forces
47 was planned. Tooth preparations for the same were per-
formed according to biomechanical principles (figure 7). The
pontic was of the sanitary type. This option assured conserva-
tion of healthy tooth structure, easily cleansable margins, wide

Figure 5 Postoperative iopa (case 1). Figure 7 Tooth preparation (case 1).

2 Naveen YG, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-010275

 Novel treatment (new drug/intervention; established drug/procedure in new situation)

Figure 8 Final prosthesis (case 1).

into destructive forces and predispose the tooth to trauma from

occlusion.
It is important to consider the following factors while restor-
ing a hemisected molar:
▸ Advanced bone loss around one root with an acceptable level
of bone around the remaining roots.
▸ Angulations and position of the tooth in the arch. A molar
that is buccally, lingually, mesially or distally titled cannot be
resected.
▸ Length and curvature of roots.3 4
Previously, in 2010, Anthony and his associates demonstrated
an alternative treatment for extraction of a whole tooth and sal-
vation of a healthy tooth structure where the patient did not
wish to have the tooth removed. In this case, a hemisected
molar was restored with individual premolar morphology on Figure 10 Final prosthesis (case 2).

the molar and adjacent premolar.5 Another case was reported by

Anshuman Kharbanda et al6, in which a hemisected mandibular
first molar was restored with a molar morphology and an inlay
type of restoration on the second molar.6
For successful treatment outcome one should select the suit-
able procedures which results in good long term prognosis and
key to this is correct diagnosis and treatment planning.

Learning points

▸ Hemisection of a mandibular molar may be a suitable

treatment option when the decay is restricted to one root
and the other root is healthy.
▸ This procedure represents a form of conservative dentistry, aiming
to retain as much of the original tooth structures as possible.
▸ Risk of caries and fracture of the remaining tooth section are
complications associated with hemisection.
▸ The planned restoration should enable the patient to
maintain oral hygiene.
▸ The success rates in such procedures are very high if cases
are selected judiciously.

Competing interests None.

Patient consent Obtained.
Figure 9 Tooth preparation (case 2). Provenance and peer review Not commissioned; externally peer reviewed.

Naveen YG, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-010275 3

 Novel treatment (new drug/intervention; established drug/procedure in new situation)

REFERENCES 4 Parmar G, Vashi P. Hemi section: a case-report and review. Endodontology

1 Rosenstiel S, Land MF, Fujimoto J, et al. Contemporary fixed Prosthodontics. 3rd edn. 2003;15:26–9.
Mosby, Inc: 2001. 5 Anthony T, Alex S, Igor J. Hemi section as a treatment option: a case report. Oral
2 Zafiropoulos GG, Kasaj A, Willerhausen B, et al. Mandibular molar root resection Health Group 2010. http://www.oralhealthgroup.com/news/
versus implant therapy: a retrospective nonrandomized study. J of Oral Implantology hemisection-as-a-treatment-option-a-case-report/1000364333/
2009;35:52–62. 6 Anshuman K, Rajiv B, Vineet S, et al. Hemi section: an alternative prosthetic
3 Ashima BB. Hemi section of a multirooted tooth-a case report. Open Access Sci Rep management. Indian J Dent Sci 2012;4:74–6.
2010;1. http://dx.doi.org/10.4172/scientificreports.336

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4 Naveen YG, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-010275